Welcome to our media digest for the week ending May 25, 2018! Each week, PI compiles a round-up of the latest public health-related news, with an eye toward media framing and language, particularly as they relate to the role of primary prevention. The views expressed in these articles do not reflect those of Prevention Institute.

This week, the Department of Housing and Urban Development discarded a key component of the Affirmatively Furthering Fair Housing rule: “the comprehensive and uniform assessment tool cities and towns needed to complete that described how housing segregation persisted in their communities and how they planned to address it… The Affirmatively Furthering Fair Housing (AFFH) rule was created by the Obama administration to help enforce the Fair Housing Act of 1968, which sought to combat the racial segregation of neighborhoods. Since the passage of the Fair Housing Act, the law has been poorly enforced and housing segregation has persisted…. The assessment tool “was having a transformative positive effect in communities across the country,” said Thomas Silverstein, counsel in the Fair Housing & Community Development Project at the Lawyer’s Committee for Civil Rights Under Laws, one of the groups involved in the lawsuit.”

On Thursday, May 24, Representative Barbara Lee introduced the Health Equity and Accountability Act, which seeks to eliminate health and healthcare disparities by changing policies and expanding federal healthcare resources to better address healthcare access and quality of care among racial and ethnic minorities, as well as populations that face discrimination and barriers to accessing health services due to immigration status, English-language proficiency, sex, age, ability, sexual orientation, and gender identity. These efforts would include a focus on eliminating health inequities, protecting sensitive locations for immigrant communities seeking healthcare services, expanding culturally and linguistically appropriate healthcare and public health services, and training the healthcare workforce to better serve and more fully represent minority communities. Senator Mazie Hirono plans to introduce the Senate companion bill once it clears the legislative council. The Congressional Tri-Caucus described the bill as a “bold, comprehensive vision for addressing persistent ethnic and racial health disparities and improving health outcomes in communities of color.”

Politico reports on California State Senator Ricardo Lara’s push to extend Medicaid coverage to all California adults, without regard to immigration status. (In 2016, California extended health coverage to all children, without regard to immigration status). Undocumented immigrants comprise approximately 60% of California’s uninsured population. The annual cost of expanding Medicaid to cover undocumented adults is estimated at $3 billion. “Lara, the son of undocumented Mexican immigrants who grew up without health coverage, contended the state is already paying for health care for the undocumented in the most expensive way possible, through hospital emergency rooms. He pushed unsuccessfully for a single payer health plan for California last year, and argues California needs to be a laboratory for social change by taking the lead on progressive causes. ‘We are trying to address the fact that, whether you like it or not,’ he said, ‘our undocumented community needs the care, and we are paying for it anyway.’” Governor Jerry Brown’s proposed state budget, released last week, did not make room for significant increases in healthcare spending, but projects a budget surplus of $9 billion. “It’s doable for a fraction of the budget surplus we have,” said Anthony Wright, executive director of Health Access California, a consumer advocacy coalition. “We recognize if we were to do so, we would be the first state to expand Medicaid to an [undocumented] adult population.”

Earlier this week, Attorney General Jeff Sessions issued a ruling that could reopen 350,000 deportation cases that the US government had previously agreed to close. Vox reports that, under the Obama administration, “prosecutors often pushed to close cases in which the immigrant had a good chance of being found eligible for some sort of relief from deportation like asylum. Immigrants had a choice: They could allow their case to get closed — they wouldn’t get legal status, but they wouldn’t be ordered deported either — or they could keep fighting to get official relief, but the prosecution would fight them every step of the way. Hundreds of thousands of immigrants took the first option. As of September 2018, there were more than 350,000 cases that had been closed and never reopened. Sessions just ruled that the whole process was illegal.” Closed cases will not be reopened automatically, but the ruling threatens the status of immigrants who “agreed to forgo a chance to seek legal status because the Obama administration wanted to close their cases and now are being punished by the Trump administration for going along with it” and puts additional pressure on immigration court judges to process deportation cases quickly, which immigrants and advocates fear will make it more difficult for judges to give individual cases full consideration.

Pennsylvania launched a $1.5 million Gun Violence Reduction Initiative to provide grants to municipalities. Pennsylvania Governor Tom Wolf and State Representative Jordan Harris have been leading efforts within government to understand and address the problem of daily gun violence. “Harris said that with all the attention and resources dedicated treating the opioid epidemic as a public health problem, the government should be willing to take a similar approach to gun violence. He called it ‘public enemy number one’ in the communities he represents. ‘When are folks going to see all the black bodies and Hispanic bodies that are dying in the streets of Philadelphia? When are we going to see them as part of the epidemic as well?’ he asked. When people separate the issue of mass shootings from broader discussions of gun violence, it can make it hard to communicate the scope of the problem, Harris added. ‘We seem to think one is more important than the other, but the mother who lost her son when he got shot on the corner on her block, she doesn’t feel any less pain than the parent of a kid who was killed in a school,’ he said. ‘There’s no less pain, no less heartache, no less grief.’”

As lawsuits advance against drug makers and others involved in supplying opioids, it’s important to put into place measures to ensure resources from any settlements or fines actually go toward preventing and treating substance misuse, write Nicolas Terry and Aila Hoss, law professors at Indiana University, in a Health Affairs blog. They note that states spent much of the settlement money from tobacco litigation on programs and resources unrelated to preventing and mitigating tobacco-related illness and make the case for avoiding a similar situation with the hundreds of claims from local and state governments and tribes seeking compensation for costs related to the opioid epidemic. They urge plaintiffs and legislators to consider opportunities to dedicate funds to both addressing community conditions that contribute to opioid misuse and providing evidence-based treatment for people struggling with opioid misuse and children born with neonatal abstinence syndrome. German Lopez provides an overview of the lawsuitsin Vox.

NPR investigates the forces contributing to the rise in deaths from opioid misuse among Latinos, including language and cultural barriers to treatment, anxieties over contact with government officials and the risk of potential deportation, and poverty and related challenges, such as unaffordable housing.

In an interview with Vox, social psychologist Keith Payne explainshow extreme inequality itself produces health problems, political polarization, and social instability. He says, “One big misunderstanding is that when people start talking about inequality, their minds go straight to poverty, but poverty’s only half of the equation. Inequality is about the size of the gap between the wealthy and the poor... The presence of extreme inequality destabilizes a society in ways that are hard to understand but absolutely devastating. For starters, it produces serious health problems, and not subjective problems but objective health problems, like chronic diseases, obesity, drug and alcohol problems, and, ultimately, shorter life expectancies. You see comparatively higher rates of these health issues in countries with the most income inequality, and that’s after controlling for average income.” These subjective perceptions of inequality produce stress: “If you perceive yourself as relatively low on the social ladder compared to others around you, it’s stressful, and the body treats that stress in the same way it treats a physical threat. So if you get the fight-or-flight response, you get immune responses that in the short term are good, but if they go on over the long term, over weeks or months, they can cause health problems.”

A House vote on the Farm Bill failed last week after the House Freedom Caucus pulled their support over a dispute within the Republican party on immigration policy. The House proposal that failed would ended access to food benefits from millions of people by imposing stricter time limits and work requirements, and ending ‘categorical eligibility’ for the Supplemental Nutrition Assistance Program (SNAP).A second vote in the House is likely in late June.

In The Verge, Cat Ferguson takes a look at how marketers troll addiction support groups on the Internet to drum up business for rehab facilities seeking well-insured patients. While online groups help connect people confronting shared challenges, they also can leave participants open to marketers seeking to exploit them in vulnerable times.

Depression diagnoses rose steeply from 2013-2016, especially among young people, according to Blue Cross Blue Shield Association’s Health of America Report. The report, based on medical claims data, found that diagnoses of major depression among teenagers increased by 47% for boys and 65% for girls. Most people diagnosed with depression had one or more additional health conditions, the report said, but it is unclear whether the conditions or the depression came first.

In an opinion piece in the Huffington Post, Philip Eil notes the surge in male celebrities, from actors to sports stars, publicly sharing their experiences with mental health challenges. He suggests these candid accounts signal a cultural shift. “Certainly, there are still millions of old-school men in this country who believe in stoicism, silent suffering and ‘being a man about’ (read: never mentioning or acknowledging) their emotions and mental struggles. But in the last few months, we’ve seen a diverse group of male celebrities dismiss that paradigm and forge a new one based on honesty, vulnerability and speaking out instead of ‘sucking it up.’” While the celebrities’ stories may be “stigma-smashing,” he says, much work remains to ensure that men feel safe speaking about mental health concerns and get help when they need it.

In a blog for Oxford University Press, Larry Cohen explores five key underlying drivers of the opioid epidemic. These factors that make people susceptible to substance misuse mirror those that contribute to community trauma: 1) loss of living wage jobs, 2) lack of economic opportunity and the accompanying sense of hopelessness, 3) frayed social connections, 4) norms that keep the problem hidden from view, and 5) lack of access to care.